Could a pulling sensation and implant movement be a sign of bottoming out? (photos)

Question

I am 4 years post op and the last couple of weeks I've felt a strange feeling in my left breast. When bending down I feel like my implant is moving, also flexing my peck muscle and lifting my arm it feels strange, not painful but almost like the muscle is pulling. I have my implants under the muscle. Otherwise no pain and the breasts are soft and looking normal.

Donovan Rosas, MD · Answer

Bottoming out refers to the descent of the implant below the level of the fold. A rising scar is often times a tell tale sign of a falling implant. A stargazing nipple is a similar sign as the breast mound autorotates upward as an implant slowly moves south.

Based on your photos, you demonstrate signs of bottoming out: -Rising scar -Stargazing NAC -Lower sitting implant

It is also important to note, the risk of bottoming out is higher when an IMF incision is used.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Daniel Barrett, MD · Answer

Dear rubilove,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ira H. Rex III, MD · Answer

A pulling sensation is very common after implant surgery, even a number of years out.  They usually, and go.  You do have an element of bottoming out, but it is impossible to say this is the cause of your sensation.

Miguel Mota, MD · Answer

Hi. Both your implants have bottomed out. This may happen due to several factors but it basically means there is not enough support on the lower pole to keep the implants above the breast fold. Bottoming out happens more often when either the breast fold is altered during surgery and or when the muscles that cover the top part of the implants push down on the implants.  
Reconstruction of the breast fold is necessary with either an absorbable mesh or using the patients own fascia or even using chest muscles to cover the implants lower half. The muscle over the top part of the implant (the pectoralis muscle) can be released a bit so that it is looser above the implant and doesn’t push down as much. This will all help avoid bottoming out in the future.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  It does appear that your implants have bottomed out with the increased length of skin from your nipple to breast fold,  high-riding nipple, and lack of upper pole breast volume relative to the lower pole.  You can have this repaired through a revision breast procedure.  Hope this helps.

John Michael Thomassen, MD · Answer

Your implants have bottomed out causing the nipples to be on the superior pole of the implants.  A surgical correction by reinforcing the lower capsule and even putting the implants over the muscle will correct this.

Karl William Schwarz, MD · Answer

Both of your implants have bottomed out as noted by a long distance between your nipples and your breast crease (infra-mammary fold).

Because of the lower location of the implants they are more easily felt and feel "funny" or "different" than they did before because they are in a different position than they have ever been. I would suggest seeing a surgeon if it is bothering you to have the pockets repaired and would suggest using a mesh to re-enforce the repair to gain more longevity in the repair.

Connie Hiers, MD, FACS · Answer

Both breasts are bottoming out in your photos. They are two different breasts so you may have two different sensations. Please wear a good support bra with underwire and go visit with your surgeon.

Manuel Diaz, MD · Answer

Hello Rubilove! I am Doctor Diaz, Plastic Surgeon. My office is at the Plastic Surgery Clinic, CECIP in the Dominican Republic. I would very much like to help you with your situation, we have the necessary tools to help you. Please leave us your number to contact you or you can contact us at +1 829 554-6062. It will be our pleasure to help you.

Camille Cash, MD · Answer

From the submitted photos it appears both implants have bottomed out.  This can be corrected, but requires surgery.  Sometimes bioabsorbable mesh can be used to give the tissues more support to (hopefully) prevent this from occurring again.  I've included a video I hope you find helpful.

Could a pulling sensation and implant movement be a sign of bottoming out? (photos)

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